Harnessing star power: public figure engagement in GI health promotion in the digital age

Abstract

Health information consumed by the public does not always originate with health professionals. Leveraging the reach of public figures to convey important health messages has had demonstrable effects on health literacy and behavior, as evidenced by the “Couric effect” after journalist Katie Couric publicly underwent a colonoscopy.1Cram P. Fendrick A.M. Inadomi J. et al.The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect.Arch Intern Med. 2003; 163: 1601-1605Crossref PubMed Scopus (330) Google Scholar In the digital age, the impact of non–health professional public figures and celebrities in amplifying health-related messages may be even more profound. Efforts are therefore needed to better understand the effects of and best approach to partnerships with public figures in health information dissemination. In this issue of iGIE, Lahooti et al2Lahooti A, Critelli B, Hassan A, et al. “The Reynolds-McElhenney effect”? The effect of celebrity endorsement on colonoscopy-related videos on TikTok. iGIE 2023.Google Scholar sought to describe the impact of a short film by the organization Lead from Behind, which features the colonoscopy experiences of public figures Ryan Reynolds and Rob McElhenney, on public discourse on the popular social media platform TikTok. The authors identified 75 videos on TikTok after searching for key words related to colonoscopy. Of these 75 videos, 46 (61.3%) were celebrity endorsements and 20 (26.7%) were created by physicians. Focusing on the top 10 most popular videos (by views) before and after endorsements, the authors showed that higher-quality videos (as determined using the validated DISCERN scoring system) were more popular after endorsement, whereas no significant association between video quality and popularity was noted before endorsement. Importantly, the study also found that the quality gap between videos by physicians and non–health professional content creators that existed before endorsement was no longer found after endorsement, suggesting possible uptake of more accurate information by the public. Investigating strategies to communicate colorectal cancer screening information is particularly relevant for TikTok’s user base, which is mostly composed of 18- to 44-year-old viewers.3Influencer Marketing Hub. The state of influencer marketing 2022: benchmark report. Available at: https://influencermarketinghub.com/ebooks/Influencer_Marketing_Benchmark_Report_2022.pdf. Accessed January 25, 2023.Google Scholar Those in the upper end of this viewer age group are approaching the age during which average-risk colorectal screening commences. On the other hand, the younger population may more likely be influenced by social media posts and personalities and thereby modify their health behavior.4Donaldson S.I. Dormanesh A. Perez C. et al.Association between exposure to tobacco content on social media and tobacco use: a systematic review and meta-analysis.JAMA Pediatr. 2022; 176: 878-885Crossref Scopus (9) Google Scholar Together with the rising incidence of early-onset colorectal cancer,5Siegel R.L. Miller K.D. Goding Sauer A. et al.Colorectal cancer statistics, 2020.CA Cancer J Clin. 2020; 70: 145-164Crossref PubMed Scopus (2291) Google Scholar,6Siegel R.L. Jakubowski C.D. Fedewa S.A. et al.Colorectal cancer in the young: epidemiology, prevention, management.Am Soc Clin Oncol Educ Book. 2020; 40: 1-14PubMed Google Scholar this study may better inform public health messaging strategies moving forward and drive investment toward partnerships with public figures specifically for a relevant screening population. There are several pertinent limitations of the study. The key words searched were limited to only colonoscopy-related terms and did not include colorectal cancer–related terms, which may have resulted in some videos being excluded. Furthermore, TikTok as a social media platform also presents several limitations on its own. When searching key words, not all results are always displayed or presented in chronological order. The popularity of videos may also not reflect organic engagement because the algorithm may not promote videos equitably on viewer feeds (and may also be impacted by past performance of videos previously posted by the same content creator). The durability of any observed postendorsement improvement in video quality is unclear. Perhaps most importantly, the mechanism by which celebrity endorsement is able to impact quality of health information is unknown. Moreover, it remains unclear if better-quality health information in this forum will truly lead to better compliance with screening recommendations or other health behaviors to improve colorectal cancer outcomes in the long term. Improving public health messaging around colorectal cancer screening must start with where the general public consumes health information. Because of the variety of platforms available, ease of use, and widespread popularity, social media has become an increasingly important and essential tool in marketing and public messaging. In health care, the roles and pitfalls of social media in health education and promotion were further magnified during the coronavirus disease 2019 pandemic.7Meppelink C.S. Bos L. Boukes M. et al.A health crisis in the age of misinformation: how social media and mass media influenced misperceptions about COVID-19 and compliance behavior.J Health Commun. 2022; 27: 764-775Crossref Scopus (0) Google Scholar A plethora of research has explored the prevalence, quality, and accuracy of health-related social media posts in a wide range of medical specialties. Not surprisingly, content with professional engagements has generally been found to be of higher scientific quality and accuracy, including a study specifically on colonoscopy-related posts.8Chiang A.L. Jajoo K. Shivashankar R. et al.Scoping out misinformation: assessing factual inaccuracies among popular colonoscopy-related videos on social media.Gastroenterol Hepatol Adv. 2022; 1: 923-925Google Scholar However, although professional creators on platforms like TikTok can leverage their expertise and technical know-how, limited recognition of these experts may reduce visibility and impact of their messaging. Although the aforementioned “Couric effect” in the age of traditional media was found to have demonstrable impact on population health behavior, the effect of celebrities and public figures on health information dissemination may be even more far-reaching in the digital media age. Therefore, partnering of health professionals with notable figures in the media with much larger followings may provide an alternate way to access segments of the general public who otherwise may not receive important health messaging. The potential extensive reach of celebrities and public figures may also be a double-edged sword in public health promotion. The greatest spike in colonoscopy-related Google search terms in 2022 occurred around the time when musician Travis Barker reportedly developed pancreatitis from undergoing a colonoscopy. At the time, social media platforms and forums were filled with content and concerning posts about this extremely rare potential adverse event. Just as public health education may be promoted through efforts by well-known figures, health misinformation and rare medical events may similarly be exponentially magnified through the lens of celebrities. This further emphasizes the vital need for closer collaborative efforts between health professionals and public figures or influencers in ensuring promotion of accurate health information and providing proper context regarding well-publicized health events. To harness the impact and reach of public figures in digestive health promotion, actions can be taken at all levels within our professional ecosystem. Increased engagement by gastroenterologists in social media and potential collaborations with known influencers would help amplify our voice and reach. Academic institutions and departments may provide media training and resources to help prepare individual health professionals in public health promotion. Hospitals and practice groups may also help engage local or national public figures as partners in health educational efforts. Professional organizations, societies, and foundations may use their influence in leveraging involvements and partnerships with public figures and celebrities. They may also provide social media templates, media toolkits, and other resources in helping both health professionals and other public figures and celebrities in generating and disseminating accurate contents. From the “Couric effect” to the “Reynolds–McElhenney effect,” celebrity campaigns may exert considerable impact on health education and promotion across traditional and digital media. Their substantial reach may help amplify public health messaging much more efficiently and effectively than most individual health providers or organizations, particularly when catering to a specific demographic like youth. Health professionals and organizations should keep an open mind and be prepared to engage with nonprofessional public figures in their efforts to educate and combat misinformation. Only through such collaborative endeavors can the “star power” of these public figures be fully leveraged to fulfill the goal of promoting and improving population health. The following author disclosed financial relationships: A. L. Chiang: Employee of Medtronic; advisory board for YouTube Health. All other authors disclosed no financial relationships.